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At the heart of general practice since 1960

Star ratings fatally flawed, admits CHI

By Nerys Hairon

The Government's star ratings regime is biased against GPs in deprived areas and clinically unsound, admits a damning report from the Commission for Health Improvement.

The devastating analysis came as Health Secretary John Reid revealed plans to overhaul performance targets for the NHS.

But Dr Reid has refused to rule out retaining star ratings.

CHI's 'commentary' on the performance indicators found PCTs in deprived areas had significantly less chance of earning high marks because it was much harder for GPs to hit cervical screening and flu vaccination targets and to curb their antibiotic prescribing.

Only one of the 30 PCTs in the most deprived areas in England achieved a three-star rating in 2003. Three-star trusts qualify for bonuses of up to £1 million.

CHI also exposed 'safety issues' surrounding the target for GPs to increase generic prescribing after acknowledging some generics had less therapeutic effect than the branded alternative. Other generics were simply more expensive than branded drugs.

Pressure to cut antibiotic prescribing also failed to take account of deprivation factors and did not measure appropriateness of use, the report said.

Report author Dr Veena Raleigh, assistant director at CHI, said: 'Deprived PCTs do less well on flu vaccines, patient surveys, cervical and breast cancer screening and prescribing of antibiotics.'

Professor Brian Jarman, emeritus professor in primary care at Imperial College London and architect of the landmark deprivation index, said pressure on trusts to cut generic prescribing failed to take into account the progress GPs had already made.

He added: 'My own view is that direct measurements of clinical outcome are the most important.'

GPC negotiator Dr Laurence Buckman said star ratings had stopped GPs doing their job and encouraged clinicians and managers 'to lie and cheat to keep politicians

happy'.

Poor star ratings of 30

most deprived PCTs

Rating Number of

deprived PCTs

0 2

1 16

2 11

3 1

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